Emotional distress and the desire to end that pain is the most prominent reason soldiers turn to suicide, according to a recent study.

"One hundred percent of the soldiers said their primary reason was to end bad feelings," said Craig Bryan, associate director for the National Center for Veterans Studies, which conducted the research. "For some, it was depression or guilt or anxiety or shame. Something bad and painful is inside of me, and I want to get rid of it."

But the issue isn't so simple, said Bryan, who also is an assistant professor in clinical psychology at the University of Utah and a former Air Force captain.

"Most soldiers had multiple reasons for attempting suicide," he said, and they ranged from relationship problems to memories of traumatic events.

And suicide can overwhelm even those who are receiving behavioral health care, Bryan said. Sometimes people die even if they are receiving good care.

"This is the harsh reality in mental health treatment," he said. "Even mental health providers are in denial of that, this mythology that if you receive mental health treatment, you're not going to die."

According to the Army, 45 percent of service members who died by suicide and 75 percent of those who attempted suicide were seen in the outpatient health care system within 30 days of their deaths.

Depression, post-traumatic stress and other issues can be chronic, persistent and fatal, Bryan said.

"Sometimes the treatment is not enough," he said. "It's tragic for the families, and it's tragic for the health care provider."

The inside look into what drives soldiers to suicide comes from a treatment study that has been going on for three years at the National Center for Veterans Studies, which does military- and veteran-focused research, Bryan said.

The study aims to better understand the primary motivations for soldiers who attempt suicide. As many as 150 soldiers from Fort Carson, Colo., who have attempted suicide are enrolled in the program.

The soldiers undergo Brief Cognitive Behavioral Therapy, a 12-session course of treatment, and Bryan and his colleagues follow up with them for two years.

The therapy focuses on teaching patients how to manage their pain, Bryan said.

"Our philosophy is you're trying to kill yourself because you don't know how else to manage your suffering and pain," he said. "We teach them how to manage this suffering without having to die. Later on, if we have to, we'll talk about trauma and depression, but right now we need to teach you how to stay alive."

Early results are promising, Bryan said, with patients receiving this therapy appearing less likely to attempt suicide.

"What our research is really zeroing in on is there are these different subpopulations within the military that may need [a] different and a more targeted approach," Bryan said, adding that one of the biggest problems with military suicide prevention efforts has been the large-scale, uniform approach.

"PowerPoint presentations, computer-based training, stick everybody in a room and you load people up with briefings," he said. "It's almost like you're lecturing them to not kill themselves, when what we know is that's not very effective."

Something as simple as having a cookout so people can build relationships and relax is beneficial, Bryan said.

"The message is what you do is important, we value your contributions," he said. "I think those types of things will be much more successful than lecturing to them."

Leaders can make a difference every day, Bryan said.

"Telling people ‘thank you' or telling them they did a good job can go a long way," he said. "A lot of people feel like, ‘Why should I congratulate someone for doing their everyday job?' The simplest, seemingly most innocuous things we can do on a day-to-day basis can have a major impact on people's emotional well-being."